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garancefranke-ruta · 8 years ago

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“Do your job!”: Rowdy Republican town halls a sign of things to come

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The town hall meeting held by House Oversight Committee Chair Jason Chaffetz in a Salt Lake City suburb Thursday night was raucous, packed — and a sign of things to come.

The meeting had to be moved to accommodate the crowd, and still hundreds of people couldn’t get in, waiting outside it and chanting, “Your last term!” after it was over. The Salt Lake County GOP knew it was going to be packed, and urged its members Tuesday to turn out to counter an expected wave of angry resistance movement attendees. It didn’t make any difference.

The room in Cottonwood Heights held more than 1,000, and was quickly filled.

Auditorium for Cong Chaffetz Town hall packed. Police say 1000 outside. Now chanting, "You work for us!" @UtahIndivisible @IndivisibleTeam pic.twitter.com/R9iDakiWrZ

— Kyung Lah (@KyungLahCNN) February 10, 2017

Attendees chanted “Let them in!” when the doors were shut, and “Do your job!” after Chaffetz, a Republican who represents Utah’s third congressional district, was pressed on why he was not conducting oversight into the Trump administration with the same vigor he’d pursued Hillary Clinton.

Cong Chaffetz Town Hall crowd chanting "Do your job!" He's having a hard time answering over crowd noise @UtahIndivisible @IndivisibleTeam pic.twitter.com/gO0BXybGy5

— Kyung Lah (@KyungLahCNN) February 10, 2017

After the Women’s March on Washington and its sister marches around the country turned into the largest street protests in American history, and after a robust array of groups helped drive the calls that led to the busiest three days in Capitol switchboard history, the progressive anti-Trump movement that’s loosely organized under the banner of “the resistance” has a third target in sight: congressional town halls.

In fact, just as the confrontational Chaffetz town hall was getting started, an online video training about how to put members of Congress on the spot at town halls was winding down. The founders of the post-election group Indivisible — which aims to build a progressive version of the tea party movement — and the representatives from Organizing for America — the advocacy group that grew out of the 2008 Obama for America campaign — had come together to teach a new generation of progressives spurred to action by Trump the fine art of putting the screws to their members of Congress during the upcoming congressional recess, which begins on Feb. 20.

Their three main messages: Organize and show up. Your member of Congress works for you. And, critically, the old Internet dictum: “Pics or it didn’t happen.”

Trainer Angel Padilla of Indivisible advised going to meetings and town halls with a group and “make sure you record, record as much as you can.” That means during the meeting, before the meeting and after meeting, too — especially if filming is shut down during the meeting. “When you get a good interaction with a member, it can really get amplified when it’s caught on video,” he said. “Go in a group. It’s easier to ignore one person.”

It’s not just publicly advertised town halls that are on the district recess agenda. Activists interested in preserving the Affordable Car Act are being urge to request town halls, too, as well as district meetings with senior staff. And they are being urged to show up at all public district events, from ribbon-cuttings to walkabouts to office hours.

Already they are coming up with creative approaches. “For Resist Trump Tuesday office visits we use a ‘Donuts with Dialogue’ model. We take donuts for staffers and target specific issues & tell stories. Each time, we have been met with respect and staffers take notes,” wrote Grace Haynes in the group chat accompanying the video call.

“Austin TX, people here are meeting every single Tuesday at lunch at John Cornyn’s office bc phone lines don’t work,” added Kristy Sprott.

The current efflorescence of activism is so intense that it comes with the risk of overloading the system and causing members to shut out even voices they might want to be listening to. “I’m in a red district and one of my MOCs has been complaining about being bombarded by individuals outside of the state. I’ve noticed that his people have stopped asking for my zip code when I call. Thinking that my calls are now being discredited be/c they are getting so many out of district,” wrote one watcher during the OFA-Indivisible training.

That’s explains the emphasis on in-person, in-district action. The entire premise of Indivisible is that members of Congress — and especially members of the House, who face voters every two years — care first and foremost about reelection, and thus about anyone who can help or hurt on that front, regardless of broader national currents of public opinion. “Constituents are really important to members of Congress and other people are not. If you’re not a member of Congress’s constituent, they don’t care what you think,” explained Matt Traldi, one of the leaders of Indivisible, during the video call. He said that after study of the tea party, which came into power when Obama had a super-majority on Congress and was enormously popular and still managed to significantly slow his agenda, or even block it, he believed that progressives could be even more effective in light of the new president’s unpopularity. “Trump’s agenda is not just a bad one, it’s also very unpopular. If we stick to the facts…we can win,” he said.

But that requires the same single-minded focus that characterized the tea party in 2009-2011. The tea party “focused on saying no to the president’s agenda,” he said. “We should absolutely replicate that right now.”

Donald Aguirre is just the sort of person the national organizers are counting on. A Utahn with what he described as “an office job” at a communications company, he co-founded Utah Indivisible along with two fellow millennials, sisters who work as a nurse and a 9/11 dispatcher. The group is one of three local Indivisible groups that turned out at the Chaffetz town hall. It’s so new it just held its first protest, organized online in opposition to the confirmation of Education Secretary Betsy DeVos, and has yet to hold its first in-person meeting. The group has drawn Democrats, Republicans and libertarians, Aguirre said. He estimated that, all told, the three Indivisible groups combined had turned out maybe 100 people to the town hall. Others came representing other groups. But many came on their own.

CNN reported from the scene that most of those at the town hall were attending one for the first time in their lives.

About this turnout: The first dozen people I interviewed at the #Chaffetz town hall said they'd never been to one before.

— Eric Bradner (@ericbradner) February 10, 2017

“Even though we had members of Congress and senators that denounced the words that Donald Trump was saying, they condemned his actions, like that video of him talking about grabbing ladies, it’s too much hypocrisy with people saying they stand for something, then they don’t. We got sick and tired of members of Congress not really representing us but towing the party line,” said Aguirre. He livestreamed the town hall on Facebook to the group. (You can watch the full Chaffetz town hall, as recorded by Aguirre, here.)

Indivisble, OFA and other activist groups such as MoveOn have also been holding twice-a-week calls to compare notes and catalog all the events Republicans are having in their districts, with the goal of fostering a massive mobilization at the local level to have an impact in a strategic way. Among the new groups they’ve been relying on in this process is the Town Hall Project 2018.

Co-founded by Nathan Williams, a political field organizer who worked on Obama’s 2008 campaign and in 2016 helped turn out voters in Las Vegas for the League of Conservation voters, and by Clinton 2016 campaign field organizer Jimmy Dahman, the all-volunteer group saw an opening after the election to give people the tools they needed to continue expressing themselves to their representatives, Williams said. They snagged an off-the-shelf interface to promote a simple concept: A Google Document with a complete list of upcoming congressional town hall meetings, launching the Town Hall Project 2018 with the help of volunteer labor from dozens of Democratic field organizers in their network. Many of them were, like Williams, unemployed after the end of the 2016 campaign. Now that guide is being used by Indivisible and other groups.

Planned Parenthood also has been actively rallying members to confront members of Congress at town halls, holding a series of forums across the country in communities beyond the big cities. That paid off in a big way Thursday night in Murfreesboro, Tenn., where Rep. Diane Black, a conservative Republican who wants to roll back Obamacare and defund Planned Parenthood, was confronted by women wearing or carrying the group’s logo.

In other news: the rowdy scene outside of a healthcare townhall in Murfreesboro, TN, tonight: pic.twitter.com/AIIeir61kz

— MJ Lee (@mj_lee) February 10, 2017

Her town hall on Obamacare was so swamped that a woman from the back of the crowd that was trying to get in cried out, “If you want to represent us, let us in!”

Chaffetz was also confronted by a Planned Parenthood patient Thursday. The national organization sent video of the confrontation to reporters Friday, in case they’d missed it.

youtube

The woman stood to testify that when she found herself at high risk for cervical cancer as a single mother of three with no health insurance, she relied on Planned Parenthood for her annual screening tests. “Sir, can you please tell me, can you explain to why you are trying to take that vital health provider away from women like me?” she asked.

Chaffetz replied with a story about his mother, who was diagnosed with breast cancer in her 30s, then drew murmurs of outrage when it seemed like he might be avoiding a direct answer and moving into a story about his wife. He shushed the crowd. “I want her to know that I care about this, and I care deeply and I care personally,” he said, seeking to address the questioner directly. His further answer — “My concern is to give that organization federal taxpayer dollars when we have so many in our community that disagree with that” and that he thought there would be “a better use of the money” — drew deep boos and shouts from the audience.

In Tennessee, a woman from Black’s district who described herself as a Christian, spoke up feelingly for the ACA as “the healthy people pull up the sick.”

Seriously urge everyone to watch this entire question from a woman at GOP #Obamacare townhall in Tennessee: pic.twitter.com/8mBGE1z6Rj

— MJ Lee (@mj_lee) February 10, 2017

“I HAVE to have coverage in order to make sure that I don’t die,” said Mike Carlson, a 32-year-old student from Antioch, Tenn., according to CNN.

"I HAVE to have coverage in order to make sure that I don't die… and you want to take away this coverage?" #ObamacareTownhall pic.twitter.com/C2JtPcOuGA

— MJ Lee (@mj_lee) February 10, 2017

But it the anger wasn’t all about ACA and Planned Parenthood. At Chaffetz’s town hall, constituents spoke up about tribal sovereignty and the Bears Ears National Monument, which was designated by President Obama and which Chaffetz opposes. A six-year-old girl spoke up on behalf of science. And a former teacher drew cheers when she asked Chaffetz, “what is your line in the sand” when it comes to impeaching President Trump.

At rowdy town hall, ex-teacher asks Chaffetz — chair of House oversight — “what’s your line in the sand” for Trump? pic.twitter.com/8U7IkpZtsS

— Dan Diamond (@ddiamond) February 10, 2017

#_revsp:Yahoo! News #_author:Garance Franke-Ruta #_lmsid:a077000000CFoGyAAL #_uuid:cc235369-5a5f-3ebe-a11d-4b5bbacb3673

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gordonwilliamsweb · 5 years ago

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Patients Want A ‘Good Death’ At Home, But Hospice Care Can Badly Strain Families

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“I’m not anti-hospice at all,” said Joy Johnston, who relocated to New Mexico years ago at age 40 to care for her dying mother.

“But I think people aren’t prepared for all the effort that it takes to give someone a good death at home.”

Surveys show dying at home is what most Americans say they want. But it’s “not all it’s cracked up to be,” said Johnston, a caregiver advocate and writer from Atlanta.

She wrote an essay about her frustrations with the way hospice care often works in the United States. Johnston, like many family caregivers, was surprised that her mother’s hospice provider left most of the physical work to her. She said that during the final weeks of her mother’s life, she felt more like a tired nurse than a devoted daughter.

Hospice allows a patient deemed to have fewer than six months to live to change the focus of their medical care — from the goal of curing disease to a new goal of using treatments and medicines to maintain comfort and quality of life. It is a form of palliative care, which also focuses on pain management, but can be provided while a patient continues to seek a cure or receive treatments to prolong life.

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According to a recent Kaiser Family Foundation poll, 7 in 10 Americans say they would prefer to die at home. And that’s the direction the health care system is moving, as part of an effort to avoid unnecessary and expensive treatment at the end of life. (Kaiser Health News is an editorially independent program of the foundation.)

The home hospice movement has been great for patients and many patients are thrilled with the care they get, said Dr. Parul Goyal, a palliative care physician with Vanderbilt Health.

“I do think that when they are at home, they are in a peaceful environment,” Goyal said. “It is comfortable for them. But,” she noted, “it may not be comfortable for family members watching them taking their last breath.”

When it comes to where we die, the U.S. has reached a tipping point. Home is now the most common place of death, according to new research, and a majority of Medicare patients are turning to hospice services to help make that possible. Fewer Americans these days are dying in a hospital, under the close supervision of doctors and nurses.

Hospice care is usually offered in the home, or sometimes in a nursing home. Since the mid-1990s, Medicare has allowed the hospice benefit to cover more types of diagnoses, and therefore more people. As acceptance grows among physicians and patients, the numbers continue to balloon — from 1.27 million patients in 2012 to 1.49 million in 2017.

According to the National Hospice and Palliative Care Association, hospice is now a $19 billion industry, almost entirely funded by taxpayers. But as the business has grown, so has the burden on families, who are often the ones providing most of the care. For example, one intimate task in particular — trying to get her mom’s bowels moving — changed Joy Johnston’s view of what hospice really means. Constipation plagues many dying patients.

“It’s ironically called the ‘comfort care kit’ that you get with home hospice. They include suppositories, and so I had to do that,” she said. “That was the lowest point. And I’m sure it was the lowest point for my mother as well. And it didn’t work.”

Hospice agencies primarily serve in an advisory role and from a distance, even in the final, intense days when family caregivers, or home nurses they’ve hired, must continually adjust morphine doses or deal with typical end-of-life symptoms, such as bleeding or breathing trouble. Those decisive moments can be scary for the family, said Dr. Joan Teno, a physician and leading hospice researcher at Oregon Health and Science University.

“Imagine if you’re the caregiver, and that you’re in the house,” Teno said. “It’s in the middle of the night, 2 o’clock in the morning, and all of a sudden, your family member has a grand mal seizure.”

That’s exactly what happened with Teno’s mother.

“While it was difficult for me to witness, I knew what to do,” she said.

In contrast, Teno said, in her father’s final hours, he was admitted to a hospice residence.

Such residences often resemble a nursing home, with private rooms where family and friends can come and go and with round-the-clock medical attention just down the hall.

Teno called the residence experience of hospice a “godsend.” But an inpatient facility is rarely an option, she said. Patients have to be in bad shape for Medicare to pay the higher inpatient rate that hospice residences charge. And by the time such patients reach their final days, it’s often too much trouble for them and the family to move.

Hospice care is a lucrative business. It is now the most profitable type of health care service that Medicare pays for. According to Medicare data, for-profit hospice agencies now outnumber the nonprofits that pioneered the service in the 1970s. But agencies that need to generate profits for investors aren’t building dedicated hospice units or residences, in general — mostly because such facilities aren’t profitable enough.

Joe Shega is chief medical officer at the for-profit VITAS Healthcare, the largest hospice company in the U.S. He insists it is the patients’ wishes, not a corporate desire to make more money, that drives his firm’s business model.

“Our focus is on what patients want, and 85 to 90% want to be at home,” Shega said. “So, our focus is building programs that help them be there.”

For many families, making hospice work at home means hiring extra help.

‘I Guess I’ve Just Accepted What’s Available’

On the day I visit her home outside Nashville, hospice patient Jean McCasland is at the kitchen table refusing to eat a spoonful of peach yogurt. Each morning, nurse’s aide Karrie Velez pulverizes McCasland’s medications in a pill crusher and mixes them into her breakfast yogurt.

“If you don’t, she will just spit them out,” Velez said.

Like a growing share of hospice patients, McCasland has dementia. She needs a service that hospice rarely provides — a one-on-one health attendant for several hours, so the regular family caregiver can get a break each day. When Velez is not around, John McCasland — Jean’s husband of nearly 50 years — is the person in charge at home.

“I have said from the beginning that was my intention, that she would be at home through the duration, as long as I was able,” John said.

But what hospice provided wasn’t enough help. So he has had to drain the couple’s retirement accounts to hire Velez, a private caregiver, out-of-pocket.

Hospice agencies usually bring in a hospital bed, an oxygen machine or a wheelchair — whatever equipment is needed. Prescriptions show up at the house for pain and anxiety. But hands-on help is scarce. According to Medicare, hospice benefits can include home health aides and homemaker services. But in practice, that in-person help is often limited to a couple of baths a week. Medicare data reveals that, on average, a nurse or aide is only in the patient’s home 30 minutes, or so, per day.

Jean McCasland’s husband hasn’t complained. “I guess I’ve just accepted what’s available and not really thought beyond what could be,” he said. “Because this is what they say they do.”

John McCasland of Goodlettsville, Tennessee, hired a private caregiver to help with his wife, Jean (left), who suffered from dementia for eight years. Even when hospice took over, he still found he needed the extra help from Karrie Velez. Jean died in October after 13 months on home hospice.(Blake Farmer/WPLN)

Families often don’t consider whether they’re getting their money’s worth because they’re not paying for hospice services directly: Medicare gets the bills. John keeps his monthly statements from Medicare organized in a three-ring binder, but he had never noticed that his agency charges nearly $200 a day, whether there is a health provider in the home that day or not.

That daily reimbursement covers equipment rentals and a 24-hour hotline that lets patients or family members consult a nurse as needed; John said it gives him peace of mind that help is a phone call away. “There’s a sense of comfort in knowing that they are keeping an eye on her,” he said.

The rate that hospice charges Medicare drops a bit after the patient’s first two months on the benefit. After reviewing his paperwork, John realized Medicare paid the hospice agency $60,000 in the first 12 months Jean was on hospice.

Was the care his wife got worth that?

“When you consider the amount of money that’s involved, perhaps they would provide somebody around the clock,” he said.

Sue Riggle is the administrator for the McCaslands’ hospice agency and said she understands how much help patients with dementia need. Her company is a small for-profit business called Adoration; she said the agency can’t provide more services than what Medicare pays for.

“I think everybody wishes we could provide the sitter-service part of it,” said Riggle. “But it’s not something that is covered by hospices.”

I checked in with John and Velez (Jean’s longtime private caregiver) this winter. The two were by Jean’s side — and had been there for several days straight — when she died in October. The hospice nurse showed up only afterward, to officially document the death.

This experience of family caregivers is typical but often unexpected.

‘It’s A Burden I Lovingly Did’

“It does take a toll” on families, said Katherine Ornstein, an associate professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York, who studies what typically happens in the last years of patients’ lives. The increasing burden on loved ones — especially spouses — is reaching a breaking point for many people, her research shows. This particular type of stress has even been given a name: caregiver syndrome.

“Our long-term-care system in this country is really using families — unpaid family members,” she said. “That’s our situation.”

A few high-profile advocates have even started questioning whether hospice is right for everybody. For some who have gone through home hospice with a loved one, the difficult experience has led them to want something else for themselves.

Social worker Coneigh Sea has a portrait of her husband that sits in the entryway of her home in Murfreesboro, Tennessee. He died of prostate cancer in their bedroom in 1993. Enough time has passed since then that the mental fog she experienced while managing his medication and bodily fluids — mostly by herself — has cleared, she said.

But it was a burden.

“For me to say that — there’s that guilt,” she said. “But I know better. It was a burden that I lovingly did.”

Coneigh Sea is a social worker from Murfreesboro, Tennessee, who cared for her dying husband, a home hospice patient. Now she wants to make sure her children don’t do the same for her.(Blake Farmer/WPLN)

She doesn’t regret the experience but said it is not one she wishes for her own grown children. She recently sat them down, she said, to make sure they handle her death differently.

“I told my family, if there is such a thing, I will come back and I will haunt you,” she said with a laugh. “Don’t you do that.”

Sea’s family may have limited options. Sidestepping home hospice typically means paying for a pricey nursing home or dying with the cost and potential chaos of a hospital — which is precisely what hospice care was set up to avoid. As researchers in the field look to the future, they are calling for more palliative care, not less — and, at the same time, they are advocating for more support for the spouses, family members and friends tasked with caring for the patient.

“We really have to expand — in general — our approach to supporting caregivers,” Ornstein said, noting that some countries outside the U.S. pay for a wider range and longer duration of home health services.

“I think what we really need to do is be broadening the support that individuals and families can have as they’re caring for individuals throughout the course of serious illness,” Ornstein said.

“And I think that probably speaks to the expansion of palliative care, in general.”

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

Patients Want A ‘Good Death’ At Home, But Hospice Care Can Badly Strain Families published first on https://nootropicspowdersupplier.tumblr.com/

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stephenmccull · 5 years ago

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Patients Want A ‘Good Death’ At Home, But Hospice Care Can Badly Strain Families

“I’m not anti-hospice at all,” said Joy Johnston, who relocated to New Mexico years ago at age 40 to care for her dying mother.

“But I think people aren’t prepared for all the effort that it takes to give someone a good death at home.”

Surveys show dying at home is what most Americans say they want. But it’s “not all it’s cracked up to be,” said Johnston, a caregiver advocate and writer from Atlanta.

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Subscribe to KHN’s free Morning Briefing.

Please confirm your email address below:

The home hospice movement has been great for patients and many patients are thrilled with the care they get, said Dr. Parul Goyal, a palliative care physician with Vanderbilt Health.

That’s exactly what happened with Teno’s mother.

“While it was difficult for me to witness, I knew what to do,” she said.

In contrast, Teno said, in her father’s final hours, he was admitted to a hospice residence.

Such residences often resemble a nursing home, with private rooms where family and friends can come and go and with round-the-clock medical attention just down the hall.

“Our focus is on what patients want, and 85 to 90% want to be at home,” Shega said. “So, our focus is building programs that help them be there.”

For many families, making hospice work at home means hiring extra help.

‘I Guess I’ve Just Accepted What’s Available’

“If you don’t, she will just spit them out,” Velez said.

“I have said from the beginning that was my intention, that she would be at home through the duration, as long as I was able,” John said.

But what hospice provided wasn’t enough help. So he has had to drain the couple’s retirement accounts to hire Velez, a private caregiver, out-of-pocket.

Was the care his wife got worth that?

“When you consider the amount of money that’s involved, perhaps they would provide somebody around the clock,” he said.

“I think everybody wishes we could provide the sitter-service part of it,” said Riggle. “But it’s not something that is covered by hospices.”

This experience of family caregivers is typical but often unexpected.

‘It’s A Burden I Lovingly Did’

“Our long-term-care system in this country is really using families — unpaid family members,” she said. “That’s our situation.”

But it was a burden.

“For me to say that — there’s that guilt,” she said. “But I know better. It was a burden that I lovingly did.”

She doesn’t regret the experience but said it is not one she wishes for her own grown children. She recently sat them down, she said, to make sure they handle her death differently.

“I told my family, if there is such a thing, I will come back and I will haunt you,” she said with a laugh. “Don’t you do that.”

“And I think that probably speaks to the expansion of palliative care, in general.”

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

Patients Want A ‘Good Death’ At Home, But Hospice Care Can Badly Strain Families published first on https://smartdrinkingweb.weebly.com/

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dinafbrownil · 5 years ago

Text

Patients Want A ‘Good Death’ At Home, But Hospice Care Can Badly Strain Families

“I’m not anti-hospice at all,” said Joy Johnston, who relocated to New Mexico years ago at age 40 to care for her dying mother.

“But I think people aren’t prepared for all the effort that it takes to give someone a good death at home.”

Surveys show dying at home is what most Americans say they want. But it’s “not all it’s cracked up to be,” said Johnston, a caregiver advocate and writer from Atlanta.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Please confirm your email address below:

The home hospice movement has been great for patients and many patients are thrilled with the care they get, said Dr. Parul Goyal, a palliative care physician with Vanderbilt Health.

That’s exactly what happened with Teno’s mother.

“While it was difficult for me to witness, I knew what to do,” she said.

In contrast, Teno said, in her father’s final hours, he was admitted to a hospice residence.

Such residences often resemble a nursing home, with private rooms where family and friends can come and go and with round-the-clock medical attention just down the hall.

“Our focus is on what patients want, and 85 to 90% want to be at home,” Shega said. “So, our focus is building programs that help them be there.”

For many families, making hospice work at home means hiring extra help.

‘I Guess I’ve Just Accepted What’s Available’

“If you don’t, she will just spit them out,” Velez said.

“I have said from the beginning that was my intention, that she would be at home through the duration, as long as I was able,” John said.

But what hospice provided wasn’t enough help. So he has had to drain the couple’s retirement accounts to hire Velez, a private caregiver, out-of-pocket.

Was the care his wife got worth that?

“When you consider the amount of money that’s involved, perhaps they would provide somebody around the clock,” he said.

“I think everybody wishes we could provide the sitter-service part of it,” said Riggle. “But it’s not something that is covered by hospices.”

This experience of family caregivers is typical but often unexpected.

‘It’s A Burden I Lovingly Did’

“Our long-term-care system in this country is really using families — unpaid family members,” she said. “That’s our situation.”

But it was a burden.

“For me to say that — there’s that guilt,” she said. “But I know better. It was a burden that I lovingly did.”

She doesn’t regret the experience but said it is not one she wishes for her own grown children. She recently sat them down, she said, to make sure they handle her death differently.

“I told my family, if there is such a thing, I will come back and I will haunt you,” she said with a laugh. “Don’t you do that.”

“And I think that probably speaks to the expansion of palliative care, in general.”

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

from Updates By Dina https://khn.org/news/home-hospice-care-unexpectedly-burdens-family-caregivers/

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